Many of these jigsaw pieces are the more quantifiable and traditional features that guidelines rely heavily on. The rest are more woolly and difficult to define, let alone describe. These are the pieces of the jigsaw that only you, the experienced clinician, can piece together. If you would like to do a bit more reading about decision making in paediatrics, here is an article published in ADC (3) which further explores that issue.
Interestingly, there is a paediatric decision tool that takes into account some of the tacit knowledge features described here. The POPS (Paediatric Observation Priority Score) includes features such as gut feel alongside physiological values (4). This scoring system is both simple and over-simple in equal measure. While it is quick, easy to do and validated, it only gives you a number at the end, not an answer or a diagnosis. That number tells you to look at the jigsaw and see what the numbers mean. The higher the number, the harder and longer you need to look and the better the explanation you need in order to be happy.
The other thing about POPS is that it doesn’t include my much-neglected feature: the trajectory of the illness. I think I’ll make a modified version of POPS which includes this. I’ll call it POPcycleS.
How do we diagnose sepsis in children?
It remains a clinical diagnosis, best made by someone who has all the pieces of the sepsis jigsaw.
Edward Snelson is a consultant in paediatric emergency medicine at Sheffield Children’s Hospital. He writes gppaedstips.blogsot.co.uk and is the author of The Essential Clinical Handbook of Common Paediatric Cases. This post was originally published on his site and is used with his permission.
This article was originally published on his blog and reproduced here with permission. Edward is raising money to help provide Free Open Access Medical Education for The Children’s Hospital Charity because of The Sheffield Children’s Hospital Rebuild. Check out his Just Giving page here.
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- Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):801–810. doi:10.1001/jama.2016.0287
- Snelson E, Ramlakhan S Which observed behaviours may reassure physicians that a child is not septic? An international Delphi study Archives of Disease in Childhood 2018;103:864-867
- Roland D, Snelson E ‘So why didn’t you think this baby was ill?’ Decision-making in acute paediatrics Archives of Disease in Childhood – Education and Practice Published Online First: 01 March 2018. doi: 10.1136/archdischild-2017-313199
- Roland D, Lewis G, Fielding P, et al. The paediatric observation priority score: a system to aid detection of serious illness and assist in safe discharge. Open J Emerg Med 2016;4:38–44.doi:10.4236/ojem.2016.42006